Bewegungsprogramm zur Prävention von Stürzen und Frakturen

 

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Zusammenfassung

Körperliche Aktivität hat bekanntlich viele positive Wirkungen auf den Bewegungsapparat und den gesamten Gesundheitsstatus. Die für eine ärztliche Beurteilung und Verordnung notwendigen Einzelheiten eines Bewegungsprogramms sind in der Praxis oft unklar und in der Theorie strittig. Der Artikel stellt ein wissenschaftlich begründetes Bewegungsprogramm zur Verbesserung von Knochenfestigkeit und Sturzrisiko vor. Diese beiden Zielgrößen werden als Kausalfaktoren für die altersassoziierten Frakturen an Wirbelsäule, proximalem Femur, Humerus, Radius und Becken angesehen. Diese Frakturtypen sind gleichermaßen durch osteoporotisch verminderte Knochenfestigkeit und erhöhte Sturzgefahr bedingt. Beide Vorgänge sind abhängig von körperlicher Aktivität und dem Alterungsprozess. Eine erfolgreiche Verbesserung durch geeignete Bewegungsprogramme ist von hoher Wichtigkeit für die Betroffenen und das gesamte Gesundheitssystem. Der Nachweis, dass Frakturen durch Bewegungsprogramme verhindert werden können, steht noch aus. Die Datenlage zur Verbesserung von Knochenfestigkeit durch Bewegung ist kontrovers. Allerdings häufen sich die Hinweise, dass Bewegungen mit hoher Krafteinleitung erforderlich und geeignet sind, Knochenfestigkeit zu erhalten oder zu erhöhen. Die vorgelegten Übungen zur Verbesserung des Knochenfestigkeit wurden auf der Basis des gegenwärtigen Kenntnisstandes zur Muskel- Knochen-Einheit entwickelt (Utah-Paradigma, Mechanostat nach H. Frost). Die Datenlage zur Sturzprävention weist viele positive Belege dafür auf, dass durch multifaktorielle Interventionen, die Übungen zur Steigerung von Muskelkraft, Muskelleistung und Balance enthalten, die Sturzhäufigkeit signifikant gesenkt werden kann. Bewegungsübungen zur Reduzierung des Sturzrisikos müssen also die neuromuskulären Sturzrisikofaktoren verbessern, d. h. Muskelfunktionen der hüftumgebenden Muskulatur und Balance. Das vorgelegte Übungsprogramm ist dazu in der Lage, wie eine eigene kontrollierte Studie zeigen konnte.

Summary

Physical activity is vital for maintaining mobility, bone strength and general health during the aging process. This prevalent opinion is brought into question when details suchastype, degree, duration, or speed of exercises are discussed. This information is necessary for a rational prescription of exercise. A program which has been designed to reduce age-related fractures has to target both bone strength and fall risk because the combination of these two factors is responsible for the steep age-related increase in fracture incidence. It has not yet been proven that fracture incidence can be reduced by exercise programs, but exercise has been shown to be able to improve DXA BMD as surrogate of bone strength and to reduce fall risk. Data concerning bone strength is, in part, controversial, but there is emerging evidence that high-impact exercise like resistance training, vibration therapy or jumping, i.e. high loading of bone, are able to prevent bone loss or even enhance bone mass. The literature is more convincing with regard to fall risk. Multi-factorial interventions comprising muscle and balance training could reduce fall incidence. The article introduces an exercise program which is aimed at both bone strength and fall risk. It comprises exercises with high force loading especially on to the hip surrounding muscles, jumping exercises which represent high power, and balance exercises. The program has been found effective in improving the chair rise test and tandem manoeuvres.

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